The socioeconomic status of your neighborhood could increase or decrease your chances of getting breast cancer, according to new research.

A new study – published in JAMA Open Network on August 29 — found that women living in areas of persistent poverty are more likely to have aggressive forms of breast cancer compared to people living in neighborhoods without persistent poverty. These women were also more likely to receive more invasive treatments and were more likely to die from the disease.

About 270,000 women in the United States are diagnosed with breast cancer each year, according to the Centers for Disease Control and Prevention (CDC). Breast cancer is the second most common type of cancer in women, but screening and treatment are strongly affected by racial and socioeconomic disparities.

“It’s a complex interaction between the environment and the conditions in which people live and biology.” Lorna McNeill, PhD, MPHsaid professor and chair of the Department of Health Disparities Research at The University of Texas MD Anderson Cancer Center Health.

Here’s what experts had to say about why a woman’s neighborhood can negatively impact breast cancer risk and how to close the gap between high-income and low-income people with the disease.

In their study, Ohio State University researchers used data from more than 312,000 women who were diagnosed with breast cancer between 2010 and 2018. On average, the women were 62 years old and about 6.4 percent—about 20,000 women – lived in areas of persistent poverty. This meant that 20 percent or more of the neighborhood’s population had lived below the federal poverty level for 30 years.

The researchers found that women with breast cancer living in these very low-income neighborhoods were more likely to have more aggressive forms of the disease, such as breast cancer diagnosed at a later stage or triple negative breast cancer (TNBC). Advanced breast cancer and TNBC are both more difficult to treat.

Women living in neighborhoods with persistent poverty were also more likely to undergo invasive treatments for their breast cancer. Among this group, mastectomies – the removal of one or both breasts – were more common. The same was true for axillary lymph node dissection, a procedure in which doctors remove lymph nodes from the armpit to prevent the cancer from spreading there.

Participants who lived in poor neighborhoods were also 10% more likely to die from the disease and had a 13% higher risk of all-cause mortality.

The researchers noted additional differences in their findings—women who identified as black or Hispanic were more likely to live in these persistently poor neighborhoods.

People living in persistently poor areas face multiple barriers social determinants of healththe author of the study Samilia Obeng-Gyasi, MD, MPHsaid assistant professor in the Division of Surgical Oncology at The Ohio State University Health.

A person’s education, employment and access (or lack thereof) to quality health care can all play a role in breast cancer outcomes, she said.

For example, women living in poverty may have harder access breast cancer screening due to lack of care centers in the area, lack of health insurance, or inability to make appointments due to work or transportation issues. As a result, these women may be at greater risk of being diagnosed at an advanced stage.

Women living in poor neighborhoods may also be more likely to be exposed to air pollution or other environmental hazards that can increase the risk of breast cancer, as well as a lack of nutritious food.

Racial disparities are closely related

Differences in breast cancer outcomes between higher and lower income neighborhoods may also be partly explained by racial demographics; Black and Hispanic women—who were more likely to live in areas of persistent poverty—face a number of breast cancer health disparities.

Although black women have a 4% lower incidence of breast cancer compared to white women, black women are 40% more likely to die from breast cancer. Hispanic women are experiencing declines in breast cancer death rates, but at a slower rate than white women.

Additionally, black women are nearly three times more likely to be diagnosed with TNBC, which is aggressive and difficult to treat, compared to white women. They are also more likely to have breast cancer detected at a later stage.

This higher prevalence of aggressive and later-stage cancers could explain why women living in persistently poor neighborhoods also underwent more aggressive treatments, Obeng-Gyasi said.

However, disparities could also play a role, he added Eric Winer, MDdirector of the Yale Cancer Center and professor of medical oncology at the Yale School of Medicine. Healthcare providers may be “less willing” to discuss less invasive treatment options with low-income patients, or patients may not understand their full range of options, he said.

“Not having health insurance, living in poverty and being a black woman, all of those things together (are) the perfect storm for a negative cancer outcome,” Winer told Health. “It’s all about systemic racism.”

While genetics may play a role in some of these breast cancer disparities, experts agree that these social determinants of health must be addressed to ensure that women of color and women living in lower-income neighborhoods do not face with worse treatment and outcomes for breast cancer.

“These neighborhoods and communities have been under-resourced and under-invested in. They lack the resources that other affluent areas have, access to healthy food, healthy places to be physically active, and are less likely to have places to go. you can get a mammographyMcNeill said. “Places like these are usually more populated by black people.”

McNeill and Winer agreed that expanding access to affordable health care in poor neighborhoods is a place to start. This could include using mobile screening clinics or investing in Medicaid or other programs that help people afford health care.

“We’ve collected enough data to know there’s a huge problem, and now it’s time to try to intervene,” Winer said. But fixing the root causes of poverty will take time, he noted.

“If you gave me the choice of developing five new drugs to treat breast cancer or to address health disparities, and asked which would have the greatest impact on breast cancer outcomes, I would say that addressing health disparities health would have a bigger impact,” Winer said. .